What are adrenal fatigue and Addison's disease? 3/26/2018 Adrenal fatigue solution
Adrenal fatigue and Addison's disease are endocrine or hormonal disorders in which the organism does not produce sufficient amounts of adrenal hormones such as cortical and aldosterone. The organism regulates hormone levels through a signaling and feedback system. Hormonal imbalances can appear for various reasons and the diseases that derive from them can become serious. In adrenal fatigue and Addison's disease, the signaling and feedback system that regulates the production of hormones involves the hypothalamus and pituitary gland (pituitary) in the brain, and to the suprarenal or renal cells located in the upper poles of the kidneys. These glands are composed of several cell layers and each of these layers produces hormones involved in the regulation of water and salts (electrolytes) of the organism, and therefore with possible impact on blood pressure. For example, cortical is produced and secreted at the level of the adrenal cortex. Its production is regulated by the hypothalamus and pituitary gland. When the blood cortical concentration decreases, the hypothalamus releases the CHR or ACTH-releasing hormone; this is a stimulus for the pituitary gland to release ACTH (or ACTH or adrenocorticotropic hormone). ACTH stimulates the adrenal glands to ensure that more cortical is produced and released. So that the organism can maintain adequate levels of cortical, it is necessary that both the hypothalamus and the pituitary function properly. When cortical or aldosterone is missing, the affected person weakens and dehydrated, is unable to maintain blood pressure within acceptable margins and responds badly to stress situations. The functions of cortical include regulating the metabolism of carbohydrates, proteins, and fats, and can affect blood glucose levels, also acting as an anti-inflammatory agent, and preparing the organism to react to situations of stress. For its part, Aldosterone is a hormone produced also in the adrenal cortex, and with the ability to regulate the saline and electrolyte balance (for example, potassium) of the blood.
There are two distinct types of adrenal fatigue depending on whether the pituitary gland or adrenal is affected. The involvement or insufficiency of the adrenal glands causes Addison's disease, also known as primary adrenal fatigue. Cortical and aldosterone concentrations are affected. The decrease in the production of the pituitary hormone ACTH (adrenocorticotropic hormone) triggers secondary adrenal fatigue. ACTH acts as a messenger of the pituitary gland and provides the signal to the adrenal cortex to start producing cortical. If there is little ACTH due to pituitary gland injury, pituitary tumor, or any other cause, cortical production is not stimulated. Secondary adrenal failure may also occur from abrupt interruptions of corticosteroid therapy (for example, prednisone, administered to relieve inflammatory pictures in rheumatoid arthritis). These treatments suppress the natural production of cortical, and it can take weeks to months to recover normal production Addison's disease affects between 1 and 4 people in 100,000; it can be given at any age and affects both sexes equally. Signs and symptoms of insufficiency may not appear until 80-90% of the adrenal cortex has already been destroyed. In adults, approximately 70% of the cases of primary adrenal fatigue are due to autoimmune processes. In the remaining 30% of cases, the adrenal lesion is due to other causes: tuberculosis (common cause in areas where tuberculosis is most prevalent); Bacterial, viral and fungal infections; HIV infection; Adrenal hemorrhages; and dissemination of cancers to the adrenal gland from some other location in the organism. More rarely can it be due to genetic disorders of the adrenal glands themselves? In children, approximately 70% of the cases are due to a congenital disorder is known as adrenal hyperplasia, while the remaining 30% is due to autoimmune processes, to another hereditary disease known as adrenoleukodystrophy or to other less common causes.
Signs and symptoms The signs and symptoms associated with adrenal fatigue are usually nonspecific. They may appear insidiously and slowly, manifesting themselves in situations of stress (mainly); subsequently, its intensity can be increased and manifested for longer periods of time (months). Signs and symptoms include: • Abdominal pain • Decreased body hair • Dehydration in Addison's disease • Diarrhea or constipation • Dizziness and fainting • Extreme fatigue or weakness
• Hyper pigmentation in Addison's disease-dark spots on the skin, especially in coetaneous folds; sometimes dark freckles appear on the forehead and face and discoloration around areas such as nipples, lips, and rectum. • Muscle and joint pain • Changes in blood pressure and heart rate • Hypoglycemia • Muscle weakness • Craving for salt consumption in Addison's disease • Vomiting • Weight loss Because the signs and symptoms of adrenal fatigue appear gradually and are nonspecific, it is possible that the affected person does not attach importance until the moment they worsen, developing at that time an adrenal crisis. In 25% of cases, adrenal fatigue is diagnosed during an adrenal or Addison and crisis, which can be severe. This crisis can be triggered by a situation that generates increased stress, trauma, surgical interventions or serious infections. In case of not being treated, it can prove fatal. Signs and symptoms of an adrenal crisis include: • Abdominal pain • Difficulty breathing • Kidney failure • Loss of consciousness • Decreased blood pressure (hypotension) • Severe pain in the lower back (lumbar area), abdomen, or legs • Severe vomiting and diarrhea leading to States of dehydration • Shock
Related tests The health care provider will suspect adrenal fatigue in signs and symptoms such as hyper pigmentation, weakness, low blood pressure, and craving for salt consumption, especially if they worsen or are more manifest during periods of stress. Laboratory tests are used to determine whether adrenal fatigue exists, and also to distinguish between primary and secondary renal failure; they will also help determine the
underlying cause of adrenal fatigue. Tests are also requested to know the individual's electrolyte status and to evaluate glucose levels and renal function. In the case of an adrenal crisis, they are requested to determine the severity of the process and to monitor the effectiveness of the administered treatment.
Laboratory tests • Cortical - blood levels usually show variations throughout the day, being higher in the early morning. If the adrenal gland does not function properly or is not properly stimulated by ACTH, then cortical levels will be consistently decreased. Cortical levels are used, along with those of ACTH and with the ACTH stimulation test to establish the diagnosis of adrenal fatigue. • ACTH - ACTH is a pituitary hormone that sends a signal to the adrenal glands to start producing cortical. This test is requested to know if the pituitary produces adequate amounts of ACTH. In an individual with adrenal fatigue, low ACTH levels are indicative of secondary adrenal fatigue, whereas elevated levels should cause primary adrenal fatigue (Addison's disease) to be suspected. The ACTH test is usually applied together with the ACTH stimulation test.
• ACTH stimulation test-this test involves measuring the level of blood cortical before and after a synthetic ACTH injection. This is the most commonly used test to establish the diagnosis of adrenal fatigue. If the adrenal glands function properly, the cortical concentration will increase in response to the stimulation of administered ACTH. If the glands have an injury or dysfunction on the contrary, then their response to ACTH will be minimal. This screening test may be requested along with a determination of basal ACTH; if it is altered, it can be completed with a prolonged ACTH stimulation test for 1 – 3 days, as this will distinguish between primary and secondary adrenal fatigue.
• Test of stimulation with CHR or ACTH-releasing hormone (ACTH) - is used when an alteration in ACTH levels is detected to determine the cause of adrenal fatigue. The CHR is a hormone released by the hypothalamus with the ability to stimulate the production of ACTH in the pituitary gland; In turn, ACTH stimulates the production of cortical by the adrenal glands. In this test, intravenous CHR is injected and the levels of cortical and ACTH are measured in a serial way, for example at 30 and 60 minutes after injection. The normal response is the detection of an increase in the concentration of ACTH, followed by an increase in the concentration of cortical. • If there is Addison's disease (involvement of the adrenal glands) an increase in ACTH is detected but not cortical. • If there is a secondary adrenal fatigue, no response from the ACTH is detected, or it is observed that the response is produced but in a delayed form. If the affectation is in the pituitary gland, no increase in ACTH concentration will occur in response to the CHR administration; if the response of ACTH occurs but is delayed, the hypothalamus will be affected. • Aldosterone-aldosterone levels in blood or urine are measured to establish the diagnosis of Addison's disease, to determine if the adrenal gland is producing aldosterone. If the levels are decreased, it will be very indicative that the individual may have primary adrenal fatigue. • Electrolytes-electrolytes (sodium, potassium, chloride) and carbon dioxide are measured to detect an electrolyte balance disorder and evaluate its severity and to monitor the effectiveness of the treatment in place. Electrolytes can be affected in a multitude of circumstances; In Addison's disease, sodium, chloride, and carbon dioxide levels are often decreased, while potassium may be greatly increased. • Urea and keratinize-these tests are used to monitor renal function. • Glucose-glucose levels may be greatly decreased during an adrenal crisis, and are of interest when monitoring the individual during the crisis.
Other tests requested occasionally • Insulin-induced hypoglycemia test-occasionally, your doctor may be interested in asking for this test to find out if adrenal fatigue may be due to a pituitary cause. Glucose and cortical levels are measured at preset intervals after having given an insulin injection with the intention of stimulating the pituitary. In healthy individuals, blood glucose levels decrease while cortical increases. When adrenal fatigue is present, cortical levels remain low while those of glucose, first decrease, and then slowly recover. • Renin-renin activity is increased in primary adrenal fatigue because the lack of aldosterone causes an increase in sodium loss. This causes a decrease in the concentration of sodium in the blood while reducing the amount of blood flow (leading to a decrease in blood volume and blood pressure); the final effect is to stimulate the production of rennin by the kidney.
• 21-hydroxylase auto antibodies are sometimes requested as part of a diagnostic process if an autoimmune-type Addison's disease is suspected. Although they are considered good markers of autoimmune Addison's disease, they are usually not commonly used.
Other diagnostic tests (non-laboratory) • Simple radiographs (x-rays) are used to look for calcifications of the adrenal cortex, as a result of tuberculosis infections. • Computed axial tomography (TAC) and nuclear magnetic resonance imaging (MRI) can be used to evaluate the size and shape of the adrenal glands and pituitary. The size of the adrenals may be increased in infections and in cancers. In autoimmune-type diseases and in cases of secondary adrenal fatigue, the size of the glands is often normal although it may be decreased.
Treatment Treatment of adrenal fatigue involves the administration of replacement hormones. The type of treatment depends on whether cortical, aldosterone or both are missing. Sometimes the adrenal function can be recovered in part when the cause of the affectation is an infection when the latter is resolved properly. On the other hand, although the involvement of the adrenal cortex is permanent and important, the affected individuals can lead a normal life with adequate treatment: the deficit hormones are replaced and some additional precautions are taken. In the case of a secondary adrenal fatigue in which the affectation is pituitary, it is already rarer that the individual can respond to the treatment. However, if the underlying cause of such an affectation can be treated (for example, if the failure is the result of a corticosteroid treatment), cortical production may be restored. Treatment of secondary adrenal fatigue also involves hormonal substitution.
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